The field of the invention relates to suture reel dispensers and suture.
For surgeons, an emphasis on working safely and quickly in the operating theatre is of paramount importance, as extra time spent during surgery can be dangerous to the patient. A patient remaining anesthetized for longer than is necessary endures more intraoperative and postoperative risks, including: atelectasis (lung collapse) which can lead to pneumonia, deep venous thrombosis (clots in the veins of the legs), pulmonary embolism (clots that leave the veins of the legs and lodge in the lung veins), stroke, myocardial infarction (heart attack), and even death. Manufacturers of equipment used during surgery strive to improve efficiency and safety.
Another major concern in the medical field is cost effectiveness. Wasting sterile instruments and equipment can be quite expensive. Any increase in cost a hospital accrues is translated into an inflated charge to individual patients. The future of medicine looks toward cost efficiency and patient safety.
By understanding the dynamics of the operating theatre, one realizes the importance of having materials and instruments ready prior to the surgeon asking for them. The basic allotment of people in the operating room involved with the surgery includes: (1) the patient; (2) the anesthesiologist; (3) the scrub nurse (sterile); (4) the surgeon (sterile); (5) a surgical assistant (sterile); and, (6) the circulating nurse (non-sterile). All instruments and materials, that the scrub nurse and the surgeon handle, must be sterile. All equipment is packaged so that while the outer cover is non-sterile, the inner package is sterile. Most equipment necessary to do a procedure is opened prior to an operation. Therefore, it is sterile and ready to use.
Moreover, in order to save money, the amount of equipment opened prior to the start of each individual operation is standardized. An estimate is made of how much material a surgeon will use during an individual procedure and the set-up is arranged so that there is, presumably, just enough material to complete a surgery. Very often during a surgery, the surgeon uses more material than what was pre-opened, requiring the surgeon to ask for more material. It is the circulating nurse""s responsibility to acquire the necessary material and/or equipment, and then pass it to the scrub nurse in sterile fashion. Since the scrub nurse, the surgical assistant, and the surgeon are to remain sterile, only the circulating nurse is allowed to retrieve the necessary material and/or equipment. This makes the surgeon dependent upon the circulating nurse. Because the circulating nurse has other responsibilities, the surgeon is constantly waiting for her/him to retrieve the necessary material and/or equipment and hand it to the scrub nurse. These delays can be very lengthy. Suture, i.e., surgical thread, is one such material that the surgeon most often asks for.
Suture is a necessary material used to tie tissue and blood vessels in order to prevent hemorrhage (bleeding). Suture comes either fastened to a needle for sewing tissue, or free of needles used to tie clamped tissue. Sutures are made of different thickness, qualities (dissolvable, biodegradable, non-dissolvable), and solid colors (black, off-white, purple and others). Suture, not attached to needles, is packaged either wrapped around a spool (suture reel dispenser) or as multiple individual ties.
Suture reel dispensers were created to increase the efficiency of dispensing suture. Spooled suture allows the surgeon to draw suture from a larger one-unit supply each time a suture is needed, rather than reaching for individual ties, of limited length. The surgeon holds the suture reel dispenser in one hand and pulls the suture to the length needed with the other hand, and then ties the tissue or vessel. The surgical assistant then cuts the suture. With the reel remaining in the surgeon""s hand, this procedure can be done over and over without needing to look away from the wound until the reel runs out of useable suture.
The medical supply companies that sell suture reels, wrap a standard amount of suture around the inner spool. A major disadvantage of prior suture and reel dispensers, is that the surgeon never knows how many ties he or she will have per reel so that he or she does not know when the suture will end until the last piece of useable suture is pulled out of the reel. Very often, the surgeon is left holding a piece of suture, which is too short to use. The surgeon must then ask for another suture reel, which often results in an unacceptable delay before another sterile reel is available for the surgeon. This delay can be detrimental to the patient""s health. One way to prevent this dilemma would be to place more suture reels on the instrument table prior to surgery. Since it is never really known how much suture will be used during any individual operation; and, since any exposed, but, unused suture must be disposed of, this wasted material adds up to an increase in the cost of health care.
One would think that a suture reel (spool) made of clear plastic would enable the surgeon to look directly at the suture reel and, thereby, have an indication of the amount of suture remaining on the suture reel. This concept, in actuality, is not feasible for several reasons. First, the width of the prior suture reel is many times the diameter of the suture. As the suture is originally loaded around the suture reel spool, it wraps horizontally and then stacks vertically to a distance of about 2 mm, measured from the center of the suture reel. As the suture isdrawn from the dispenser, the suture reel rotates in reverse to the way the suture was loaded; horizontally, approximating one layer at a time, thereby vertically reducing the amount of previously loaded material. Several revolutions of the suture reel decreases the vertical distance of the suture from the center of the suture reel by a miniscule and practically unnoticeable amount. In order to observe the suture winding down, the surgeon would have to continuously look at the suture reel when pulling the suture out of the suture reel dispenser; by which action, would take the focus of the surgeon off the operation and, therefore, would be unacceptable. In reality and actual practice, surgeons keep his or her focus and attention directly on the operation and, therefore, looks away from the wound as little as possible.
Another disadvantage of the prior suture reel dispenser is difficulty in handling it. A suture reel dispenser must operate in a manner that allows the suture reel to rotate smoothly and freely, without a need to place undue tension on the suture in order to draw it from the suture reel dispenser. The prior suture reel dispenser contains a suture reel attached to a reel housing and is constructed so that the reel housing does not completely cover the suture reel. The apparatus is quite small, which makes it difficult to hold the suture reel dispenser without the surgeon""s fingers touching the suture reel. Moreover, surgeons wear gloves, which makes this task even more arduous. Friction on the suture reel from the surgeon""s fingers both increases the force necessary to pull the suture out of the suture reel dispenser and prevents the suture reel from turning freely. For example, at times, while the surgeon is pulling suture from the dispenser, the whole apparatus can become dislodged from the surgeon""s grasp, caused by an abrupt stopping force or tension, when the suture reel does not rotate smoothly. Furthermore, the required smooth, rotating action of the suture reel, on its built-in axle, can easily be inhibited by any slight increase in friction on the reel body or by the lodging of the suture in the suture reel or dispenser, or by a combination of several of these factors. Any disruption of a normal, smooth dispensing action of the suture, results in the surgeon""s attention being diverted away from the operating field; thereby causing an unacceptable delay and is, most always, quite frustrating to the surgeon.
Lastly, another disadvantage of prior suture reel dispensers is that some suture needs to be moist, however, housing mechanisms are developed to house dry suture. Liquid can be placed into the housing but there is no guarantee that this will continuously be in contact with the suture. Therefore, by providing a means of placing a device onto the housing which is connected to the spool and spins freely with the spool; thus, not effecting the mechanism of the reel dispenser.
The foregoing difficulties and disadvantages are overcome by the present invention, which provides methods, material and apparatuses including a suture reel dispenser mechanism. The present invention first proceeds by providing means to enable a surgeon to discern when the end of a suture reel is near. The indicia can be a visual marking on the suture, or it can be an audible and/or vibratory effect. Alternatively, or in addition, the horizontal extent of the wrapped and stacked suture is limited so that the suture is wound with a greater vertical extent, enabling the surgeon to more easily determine when the end of the suture is near.
Still another embodiment of the present invention provides a housing method and mechanism for the suture reel dispenser mechanism.
Yet, another embodiment of the present invention provides alternative methods and mechanisms for housing the suture dispenser and prevent the suture from unwinding.
Lastly, another embodiment of the invention provides a means to keep the suture moist.
In summary, a suture reel and suture reel dispenser and housing mechanism combination are provided that are easy to handle, operate dependably and reliably, and enable surgeons to immediately know when he is about to run out of suture. This invention eliminates delays in obtaining sufficient suture, and as a result, one need not overstock suture at the surgeon""s station, thereby reducing waste.
Visual Indicia On Suture. In one embodiment of the invention, suture utilizing the present invention is imbedded, marked, tagged or applied with visual indicia, which can be, e.g., a different color on the final end, or solid, alternating vertical, alternating diagonal, striped, alternating dotted, hatched patterns, or a combination of any pattern, mixed with one another, or placed sequentially next to one another. The indicia is stationed at the end of the reel loaded suture immediately adjacent to and/or anchored to the spool body, for a specified length from the suture end, differentiating it from the suture ahead of the indicia. The indicia thereby indicates that a predetermined quantity of reel loaded suture is coming to an end. The remaining suture will be long enough, from the point of differential indicia (identification point) to the physical end of the suture, for the surgeon to request more suture, as needed, and continue working. The surgeon""s eyes rarely leave the wound, therefore, he/she is always looking at the suture as the material comes out of the dispensing apparatus, a viewpoint which is generally within the surgeon""s same scope of view of the wound. When the suture changes to visual indicia, the surgeon will immediately know that the suture is near the end of the reel loaded quantity of suture and can immediately call for another suture reel. During the time it takes for the circulating nurse to obtain the new reel, the surgeon can continue to work with the remaining useable indicia marked suture.
Audible and/or Vibratory Indicia. In another embodiment of the invention, a suture reel dispenser is provided that indicates when the suture is nearing its end by making a noise, a vibration or both. The suture reel dispenser is constructed with a plurality of nibs or other similarly functioning device, which can be of different designs and configurations, and which, at a specified length of suture, will cause an audible indicator, a vibratory indicator, or both, to signal the surgeon that the supply on the reel of suture is coming to an end. When the suture reel begins making a noise or causes a vibration, the surgeon will know that the suture is coming to its end, without looking away from the wound. The surgeon can immediately call for another reel and during the time it takes for the circulating nurse to obtain the new reel, the surgeon can continue to work with the remaining useable suture.
View Windows In the Suture reel and/or Housing. In this embodiment, one or more view windows (which can also be called ports) are placed in the suture reel and/or the suture reel housing, which allow the surgeon to simultaneously observe the remaining amount of useable suture on the suture reel and easily approximate when the wound suture will be coming to its end. By quick observation of the suture through on or more viewing windows, the surgeon, will, by changes of visual indicia within the background of the view window, immediately know that the suture is nearing its end.
In order for a view window to function properly, one needs to change the manner of stacking the suture on the reel. The diameter of prior suture reels are extremely wide relative to the width of the suture itself and preclude the use of one or more view windows. In accordance with another embodiment of the invention, the suture reel is designed and constructed to accommodate the specific diameter of any suture, which forces the suture to load around the suture reel hub in a radial fashion, one suture diameter wide, creating a uniform stacking effect. Therefore, when the surgeon draws the suture off the suture reel, each revolution of the suture reel results in the reduction of the loaded suture, sequentially, by one suture diameter (one layer being equivalent to one suture diameter). The surgeon can immediately observe this change through an integral view window. In a further embodiment, the background of the view window changes near the end of the suture, which is revealed when the suture winds down.
Since the surgeon""s eyes rarely leave the wound, and since the suture reel dispenser is in his/her hand, within close proximity to the wound, he/she can easily look at the view window in or on the suture reel or suture reel housing. This embodiment can be provided as the sole indicia or it can be provided along with the visual, audible and/or vibratory indicia referred to above. When the view window changes visual indicia, the surgeon will know that the suture reel is near the end of useable suture. When the surgeon first notices the suture reel is near the end of useable suture, he or she can immediately call for another suture reel. During the time it takes for the circulating nurse to obtain the new suture reel, the surgeon can continue to work.
Suture Dispenser. In still another embodiment of the invention, the suture reel is encased within an enclosed suture reel housing. The suture exits through an opening within the suture reel housing. The exit port of the enclosed suture reel can be used as an instrument to help place suture around other instruments.
However, with the suture reel completely enclosed within the reel housing, it can not be stopped by friction created by the surgeon""s fingers. The suture reel, therefore, continues to turn freely and smoothly until the reel dispenses all of the contained suture. A disadvantage of prior suture reel dispensers is the inability of the surgeon to prevent the suture from coming out of the housing while trying to manipulate the suture. For example, when the surgeon is trying to place the suture around clamps or when he is tying knots with the suture. When pulling the suture in order to tie a knot, the free end of the suture is held in one hand, while the other end of the suture contained within the suture reel mechanism is held within the opposite hand. Hence, when pulling the free end of the suture during this manipulation, the suture continues to unwind from the suture reel dispenser. Therefore, by creating a devise/apparatus on the suture reel dispenser that when depressed will prevent the suture reel from spinning, the suture reel dispenser can be used to create tension on the suture in order to help place the suture around the clamps and help tie knots.
A mechanism to manually prevent the suture from unwinding. This embodiment of the invention creates a devise/apparatus on the enclosed suture reel dispenser that when depressed will prevent the suture from leaving the suture reel housing mechanism. It involves placing a device onto the housing which is connected to the spool and spins freely with the spool. The device has a flange or arm which can be raised in order to rewind excess suture. When not needed for re-winding, the flange or arm can be laid flat so as to not interfere with the smooth circular motion of the spool as suture is pulled from the suture. Furthermore, since the mechanism is attached to the spool, the user can place direct pressure on the mechanism in order to prevent the suture from unwinding. This tension is useful when placing suture around clamps, and when tying suture.
A housing mechanism for the suture reel mechanism. This embodiment the invention, creates a partially enclosed suture reel, where the spool is exposed in order to give the user the ability to apply pressure directly to the spool when needed such as to tie suture. The spool is not exposed, although it has the same exit design as enclosed suture reels known to the art.
A mechanism to keep the suture moist. This embodiment of the invention places a sponge-like substance within the exit site of the suture reel housing, or on a cam placed within the housing if feasible. Both of these structures are in constant contact with the suture and both can be impregnated with fluid to keep the suture moist at all times.
In each of the embodiments of the invention delays encountered with prior systems become negligible or non-existent, being supplanted by manageable, cost reducing methodologies. Moreover, only the amount of suture needed is used. This invention both increases patient safety by decreasing the time in the operating room, and directly contributes to reducing the cost of surgery by decreasing the amount of wasted suture and increasing the efficiency of the operating staff.